Provider Demographics
NPI:1588905327
Name:QUONCE, KIRIN ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIRIN
Middle Name:ANN
Last Name:QUONCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIRIN
Other - Middle Name:ANN
Other - Last Name:COFANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:735 BUCKEYE RD NE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4526
Mailing Address - Country:US
Mailing Address - Phone:910-524-0475
Mailing Address - Fax:
Practice Address - Street 1:2206 WRIGHTSVILLE AVE STE A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2406
Practice Address - Country:US
Practice Address - Phone:910-763-6499
Practice Address - Fax:910-632-2355
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0140091041C0700X
NY0899831041C0700X
NY087152-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06215190Medicaid